- What is a cochlear implant?
- What is a “sensorineural” hearing loss?
- What does the inner ear do?
- How does a cochlear implant work?
- If I have a cochlear implant, will I be tied to a machine?
- Does cochlear implantation harm the inner ear?

- How bad does my hearing have to be for me to need a cochlear implant?
- What kind of evaluation is involved with getting a cochlear implant?
- Will my insurance cover a cochlear implant?
- I can still hear some things with my hearing aid, but I cannot understand people unless I look at their lips.
  Should I risk losing this and get a cochlear implant?
- If I am deaf in one ear, but I can still hear in the other, can I get a cochlear implant to restore the hearing in my deaf ear?

- I have been deaf all my life, am I a candidate for cochlear implantation?
- Will sounds sound “normal” with a cochlear implant?
- What will I hear when the implant is off?
- How many types of cochlear implant are there?
- What decides which implant is right for me?

- How long does the operation take?
- Will I have any visible scars?
- Will I be asleep?
- How long will I be in the hospital?
- Will I have a bandage?

- Will I have much pain?
- Will I be dizzy after the surgery?
- Can I fly after surgery?
- Will a laser be used?
- Why do I have a funny taste in my mouth?

- When do I get to hear?
- What else can be done to help me use my implant?
- Will this help my tinnitus?
- Do cochlear implants ever break?
- Should I have the other side operated on, too?

What is a cochlear implant?
A cochlear implant is an electronic device that is surgically implanted into the inner ear. It can deliver sound, in the form of electrical impulses, to the inner ear. It is a way of returning sound perception to people who have lost their hearing due to a sensorineural hearing loss.

What is a “sensorineural” hearing loss?
There are two forms of hearing loss. A conductive hearing loss means that there is a problem with the mechanisms used to transmit sound into the inner ear. In a conductive hearing loss, the inner ear is normal. A sensorineural loss the conductive mechanism is normal, but there is a problem with the inner ear.

What does the inner ear do?
The inner ear is where the sound that comes into the ear is transformed into nerve impulses that are sent to the brain.

How does a cochlear implant work?
In general, a microphone receives the sound and transmits it to a speech processor unit. The speech processor converts the sound to electrical signals that are transmitted to an external coil. Below the external coil is the internal coil, implanted below the skin. A magnet in each coil keeps them close together. The internal coil picks up the signals from the external coil and sends them to the internal electrodes implanted in the inner ear. These electrical signals stimulate the nerve cells still in the inner ear and give the patient the perception of sound.

If I have a cochlear implant, will I be tied to a machine?
All cochlear implant designs have always be designed to be as mobile and can go anywhere with the patient. The speech processor component was usually worn on the belt like a personal stereo. All never designs have an “ear-level” processor, where all of the device is worn on the ear.

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Does cochlear implantation harm the inner ear?
Placing the electrodes into the inner ear destroys the remaining hearing in the ear. This is why cochlear implantation is only considered if the patient has no useful hearing.

How bad does my hearing have to be for me to need a cochlear implant?
A cochlear implant is meant for patients who have lost the ability to use their hearing, even with the most powerful hearing aids. If a patient cannot understand speech with the most powerful hearing aids, they would do better with a cochlear implant.

What kind of evaluation is involved with getting a cochlear implant?
The implant evaluation involves input from all members of the implant team. This includes a medical evaluation by an ear specialist and an audiologist. It may involve an evaluation by a psychologist or a deaf education specialist. Often a CT scan or MRI are needed as well.

Will my insurance cover a cochlear implant?
Some plans cover the implant, some don’t. Some will cover the surgery, but not pay for the actual device (which costs about $20,000). Often, the implant is initially denied, but payment is granted on appeal. Some plans flat-out deny coverage. Often, we cannot know if it is a covered service until a surgery is scheduled. When the coverage is denied, the implant team will contact you regarding appeals and will write letters on your behalf. The manufacturers also have personnel to assist in obtaining coverage.

I can still hear some things with my hearing aid, but I cannot understand people unless I look at their lips, should I risk losing this and get a cochlear implant?
Studies have shown that the most of the patients with a cochlear implant will learn to understand speech without the need for lip-reading. Nearly all will find it helps them more than their hearing aid.

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If I am deaf in one ear, but I can still hear in the other, can I get a cochlear implant to restore the hearing in my deaf ear?
A cochlear implant does not restore normal hearing to an ear. It provides signals that can be perceived as hearing, but the brain needs to learn how to interpret, or “hear”, those signals. If normal hearing is being used on the opposite ear, the brain will never learn to use these signals and will interpret them only as noise. A patient is better off using just their remaining ear rather than using a cochlear implant. Cochlear implants are only done on people who are deaf in BOTH ears.

I have been deaf all my life, am I a candidate for cochlear implantation?
There are three types of implant candidates: post-lingually-deafened adults, pre-lingually deafened adults and pre-lingually deafened children. Post lingually deafened adults are persons who have lost their hearing later in life, after they have learned to speak and communicate with sound. These patients generally do not learn sign language well and are ideal candidates for cochlear implantation, in whom they work very well. Pre-lingually deafened children, who have no hearing and have not acquired speech, are also good candidates because their brains have a much greater ability to adapt to using the cochlear implant. The worst results are encountered in the pre-lingually deafened adults. They have neither acquired speech nor learned to use sound communication. Their communication abilities are generally sight-based and their brains no longer have the flexibility to adapt to the signals from the implant. Most often, these patients perceive the signals from the implant as bothersome noise and are never able to appreciate the information these signals carry. It is only with great reluctance that we consider implantation in a pre-lingually deafened adult, and then only when we are sure that the patient realizes his expectations of success should be low.

Will sounds sound “normal” with a cochlear implant?
Although the implant can provide hearing to a deaf patient, it does not restore normal hearing. The sound is different and is often described as “tinny” by implant users.

What will I hear when the implant is off?
When the implant is turned off or not connected to the patient, the patient can hear nothing from the implanted ear. Some patients will experience tinnitus, or noise, in this situation.

How many types of cochlear implant are there?
There are three cochlear implant designs available in the United States: the Nucleus, made by Cochlear Corporation; the Clarion, or Bionic Ear, made by Advanced Bionics Corporation; and the Combi 40++, made by Med-El Corporation. Each design has a proven track record of success and each is offered here at Temple.

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What decides which implant is right for me?
At many cochlear implant programs around the country, only one type of implant is offered. At Temple, we offer all three implant designs because each has features and advantages that are unique. We try to provide the patient with the device that will provide them with the best result for him or her using an individualized approach. In general, the hearing results for all three are going to be nearly the same—so in terms of hearing, each design is excellent. You will be told about each design and its advantages and disadvantages and you and the implant team will come to a conclusion about which implant is best for you.

How long does the operation take?
The operation usually takes two to three hours. It is outpatient surgery and the patient goes home the same day.

Will I have any visible scars?
The surgical incision is behind the ear and up into the scalp. The scar is usually hidden in the hair and not easily visible. Often, the patient will need to keep a small area of hair trimmed short to place the external coil.

Will I be asleep?
The operation is done under general anesthesia and the patient is completely asleep throughout the procedure.

How long will I be in the hospital?
The surgery is an outpatient procedure and the patient usually goes home the same day. On rare instances, a patient may stay one night.

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Will I have a bandage?
A large bandage is placed over the incision and wrapped around the head at the close of the surgery. This dressing will need to stay on for one day and will generally be removed in the office the day after surgery. Rarely, the patient may be asked to removed their bandage themselves.

Will I have much pain?
All operations hurt to a degree. Pain medicines are given for when you go home and will generally be needed for about a week.

Will I be dizzy after the surgery?
Dizziness is not uncommon after surgery. If it is severe, the patient may need to stay for a night in the hospital. In most cases, however, the dizziness can be controlled with medicines at home. The dizziness rarely lasts more than a couple of days. If it persists for weeks after the surgery, there may be leakage of fluid out of the inner ear and a revision surgery may be needed

Can I fly after surgery?
There is no contraindication to flying after cochlear implant surgery. Many people who use cochlear implants find them difficult to use in noisy environments, such as an airplane, and will switch it off during flight.

Will a laser be used?
No. There is no role for lasers in cochlear implantation.

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Why do I have a funny taste in my mouth?
There is a small nerve that passes through the ear called the Chorda Tympani nerve. It is a nerve that transmits some aspects of taste from the front part of the tongue to the brain. It is often exposed when entering the middle ear through the mastoid. It is rarely injured, but if it is, it will result in a metallic, numb feeling on the sid of the tongue. This feeling will resolve in one to several months.

When do I get to hear?
The device is not connected until a month after the surgery. This allows complete healing to take place before stimulation is attempted. About one month after surgery, the patient will return to the Audiology Department for their initial “hook-up”. This appointment usually takes a couple of hours. During this appointment, the initial “mapping” is performed. Mapping involves testing each electrode to find out what kind of sound is perceived and how much stimulation it needs. The patient’s speech processor will then be programmed to deliver signals based on that mapping. The patient is then asked to use the device as much as possible over the next couple of months to get used to it. Further follow-up appointments will be needed to try different speech processor programs or remap the electrodes.

What else can be done to help me use my implant?
Implant users are also routinely sent for auditory verbal therapy. This is a form of speech therapy where the patient is trained to use what hearing they have to the fullest. We also encourage people to use their implants in as many hearing situations as possible. In general, the more the implant is used, the better the patient gets at using it.

Will this help my tinnitus?
Cochlear implant patients frequently note a reduction in their tinnitus after implantation. Generally, however, the results are unpredictable and rarely the tinnitus will worsen. If it improves, it may only improve when the implant is attached and turned on.

Do cochlear implants ever break?
Yes, cochlear implants can break, but fortunately it is rare. A malfunction can occur in any of the components, both external and internal. All implant companies offer limited warranties on both the internal and external components, with options for extended warranties. In addition, internal components of the implant can be injured by direct trauma. If there is failure of the internal components of an implant, the patient my require a surgery to remove that implant and place a new one.

Should I have the other side operated on, too?
Bilateral, or both-side, implants are currently being investigated in special studies at certain implant centers. Initial results suggest it may be beneficial to implant both sides. Currently, except at these special centers and under strict scientific scrutiny, only one side is implanted. It is possible, however, that second-side implantation may be offered in the future.

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